Provider Demographics
NPI:1447226246
Name:PEREZ, ASTAIRE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:ASTAIRE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1012
Mailing Address - Country:US
Mailing Address - Phone:848-482-7230
Mailing Address - Fax:
Practice Address - Street 1:625 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1012
Practice Address - Country:US
Practice Address - Phone:848-482-7230
Practice Address - Fax:858-482-7229
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00996900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091667U8JMedicare PIN
NJ091667Medicare PIN
NJ091667PSVMedicare PIN